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Long-term outcome after obstetric injury: a retrospective study
1Department of Obstetrics and Gynecology, Falu Hospital, Falun, Sweden. janchrister.sundquist@ltdalarna.se
Objective:
To examine problems experienced by women after vaginal delivery with and without a sphincter tear and compare those with less and more severe injuries.
Design:
Retrospective questionnaire study. Setting. Regional hospital in Sweden.
Sample:
A total of 324 women with and 309 without sphincter tears.
Methods:
Questionnaires were sent out four to eight years after delivery enquiring about the existence and time course of gas incontinence, fecal incontinence, dyspareunia and perineal pain. A question about vacuum delivery was also included.
Main Outcome Measures:
Prevalence of persisting symptoms.
Results:
The reply rate was 77%. About 10% of the women with a sphincter tear had fecal incontinence initially, compared with 3% among those without a sphincter tear. In women with moderate or severe tears, 20 and 31%, respectively, had gas incontinence, compared with 6% of women without a tear. Dyspareunia and perineal pain were present 18-23% of women in the tear groups compared with 9-12% of those without a tear. Almost 45% of women with initial symptoms had remaining problems after four to eight years. There was a significantly higher risk for symptoms after vacuum extraction (p < 0.001).
Conclusions:
Gas incontinence, fecal incontinence, dyspareunia and perineal pain were common problems after delivery. The prevalence of persisting symptoms was high even among women without a tear. The higher prevalence after vacuum extraction delivery indicates that there are more complications associated with this mode of delivery than previously thought.
